title: Elective treatment of abdominal aortic aneurysm is reasonable in patients >85 years of age.
abstract: BACKGROUND
  The numbers of patients >85 years of age referred for abdominal aortic aneurysm (AAA) repair have increased in recent decades. With the population aging, increased screening of AAA, and introduction of less invasive surgical techniques, vascular surgeons will be treating more elderly patients. Few data are available for estimating the risks and benefits of prophylactic repair among those with such an advanced age. The aim of this single-center study was to evaluate the short-term to midterm results after AAA repair in patients >85 years of age.
  
  
  METHODS
  Between 2004 and 2012, data of patients >85 years old who required an elective AAA repair at our institution were collected prospectively. According to the current guidelines, patients underwent endovascular aneurysm repair (EVAR) each time the aortic anatomy was suitable. Open repair (OR) was performed in those patients with hostile proximal neck anatomy and/or severe iliac tortuosity. Type of repair (EVAR or OR) and perioperative and midterm outcomes were analyzed. Primary end points were 30-day mortality and midterm survival.
  
  
  RESULTS
  Among 1016 patients undergoing elective AAA repair during the study period, 59 (5.8%) were ≥85 years of age (54 men, mean age 87 ± 2 years), with a mean aneurysm diameter of 61.5 ± 20.3 mm. Thirty-three patients (56%) underwent EVAR and 26 (44%) had an OR. Thirty-day mortality was 6.7% (6% with EVAR and 7.6% with OR, P <0.05). Mean follow-up was 24.7 ± 18 months. Kaplan‒Meier analyses for survival were 85.5%, 64.5%, and 50% at 1, 3, and 5 years, respectively. No aneurysm-related death was observed during follow-up.
  
  
  CONCLUSIONS
  Elective repair may be proposed in patients >85 years of age in cases of threatening AAA, showing acceptable perioperative mortality and reasonable midterm survival results. Even if EVAR did not seem to offer significant benefits in perioperative mortality in our study, it appears reasonable to suggest this less invasive technique as first-line treatment in cases of suitable anatomy in such an advanced-age population.
authors.affiliation: Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: de Blic
authors.affiliation: Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France. Electronic address: jean-marc.alsac@egp.aphp.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
authors.affiliation: Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Julia
authors.affiliation: Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Salma
authors.initials: S
authors.lastname: El Batti
authors.affiliation: Department of Vascular Medecine, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Mirault
authors.affiliation: Department of Interventional Radiology, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Di Primio
authors.affiliation: Department of Interventional Radiology, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Sapoval
authors.affiliation: Department of Vascular Medecine, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Messas
authors.affiliation: Department of Cardiac and Vascular Surgery, Hôpital Européen Georges-Pompidou, Aphp, Faculte René Descartes, Paris, France.
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Fabiani
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010297:Paris; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome